Asthma Control Worldwide Remains Less Than Ideal

The management and control of asthma across age groups is often inadequate, especially in lower-income nations, according to a global cross-sectional study.

Across the 25 nations included in the study, which included over 25,000 individuals with asthma confirmed by a doctor, plans used to assist in the management of asthma symptoms were used in 62.8% of children, 53.4% of adolescents, and 47.4% of adults, reported Luis García-Marcos, PhD, of the University of Murcia in Spain, and colleagues from the Global Asthma Network Phase I Study Group.

Well-controlled asthma was seen in 44.1% of children, 55.4% of adolescents, and 61.1% of adults, they detailed in The Lancet Global Health.

Across the three age groups, patients residing in low- or middle-income countries had a higher likelihood of poor asthma control compared with those in high-income nations:

• Children: adjusted OR 2.33 (95% CI 1.32-4.14)
• Adolescents: OR 3.46 (95% CI 1.83-6.54)
• Adults: OR 4.86 (95% CI 2.55-9.26)

Regardless of patients’ asthma severity and country income level, those on a management plan in each age group were nearly twice as likely to be on oral medicine for their asthma and more than twice as likely to receive inhaled treatments.

“Improved asthma control is an urgent need worldwide, particularly in children and in less affluent countries,” the group wrote. “Improving the availability and affordability of inhaled medicines in less affluent countries should be a priority.”

Among those that did use medication, the most common were inhaled corticosteroids and inhaled short-acting β2 agonists (SABA), with medication use tending to increase directly alongside the severity of symptoms for participants in each age group. However, 44.8% of children, 60.1% of adolescents, and 55.8% of adults experiencing severe asthma were not on inhaled corticosteroids.

“We’ve got this lack of control in many asthma cases, and that causes an enormous morbidity,” García-Marcos said in an audio interview that accompanied the study. “You shouldn’t, apparently, have any mortality from asthma, but in fact you’ve got it, and those deaths are probably perfectly avoidable if we use treatments correctly.”

In the U.S., 25 million people are living with asthma and nearly 2 million visit the emergency department as a result each year, according to data from 2020. That year, over 4,000 deaths were attributed to the disease, including 204 among children.

“Inadequate asthma control can be a consequence of several factors, such as doctors not following guidelines or strategies, poor adherence by patients to the recommended treatment regimen (including inhaler technique), poor access to health care, unavailability or unaffordability of essential asthma medicines, or a combination of these factors,” the study authors wrote. “Many studies have addressed ways of improving adherence in the past two decades. Both individual and community-based interventions to improve awareness, adherence, and availability of medicines usually yield good results, as measured by access to medicines, reduced emergency visits and hospitalizations, or improved quality of life.”

In an editorial that accompanied the research, Mariëlle Pijnenburg, PhD, of the University Medical Centre Rotterdam in the Netherlands, and Ian Pavord, MD, of the University of Oxford in England, called for improved access to healthcare as a way to combat asthma severity around the world.

“Depending on the global region, increased availability and affordability of asthma medications, improved implementation of guidelines, objective asthma diagnosis, and biomarker-guided management are all strategies that could reduce the global burden of asthma,” the editorialists wrote. “If these strategies are implemented, we might finally see a global survey that shows improvements in outcomes.”

In the audio interview, study co-author Refiloe Masekela, PhD, of the University of KwaZulu-Natal in Durban, South Africa, argued that all patients with asthma should have an action plan: “Whether you have an exacerbation, you should know which medication to use for an attack, how often to use it, when to present to a doctor.”

Masekela noted that in the lower-income countries especially, it seemed to be only patients with more severe symptoms who had these plans. “That also just talks to one of the gaps that needs to be addressed — that we are not giving enough, or sufficient, education to our patients to have access to these,” she said.

To fill such a need, Pavord and another group of researchers recently proposed a single-page guide, published in The Lancet Respiratory Medicine, containing diagnostic and therapeutic approaches to facilitate the implementation of current asthma guidelines in non-specialized settings, where patients often receive care.

The Global Asthma Network Phase I Study included a total of 453,473 participants from 25 countries, including 6,445 children, 12,532 adolescents, and 6,677 adults with asthma confirmed by a doctor. For inclusion, a validated questionnaire on health visits and asthma symptoms was sent to participants in the three age groups: children ages 6-7 years, adolescents ages 13-14 years, and adults 19 and over.

Participants in high-income countries reported the greatest proportion of asymptomatic asthma.

There are several limitations to the study, the group noted, including that information on asthma severity was linked with medicine use, so changes as a result of treatment could not be assessed. They added that recall bias may have affected results as well.